Heel Bone Fracture

The heel bone, also known as the calcaneus, is a vital component of the rear part of the foot. It serves as a foundation and connects with the talus and cuboid bones. The connection between the talus and calcaneus forms the subtalar joint, which is critical for normal foot function. When the calcaneus is fractured, it can cause severe injuries and long-term consequences such as arthritis and chronic pain.

Calcaneal fractures are often the result of a traumatic event such as falling from a height or being in an automobile accident where the heel is crushed against the floorboard. Other types of injuries such as an ankle sprain may also lead to calcaneal fractures. A smaller number of calcaneal fractures are stress fractures, which are caused by overuse or repetitive stress on the heel bone.

Fractures of the calcaneus may or may not involve the subtalar and surrounding joints. The most severe calcaneal fractures are intra-articular fractures, which involve damage to the cartilage, the connective tissue between two bones. The outlook for recovery depends on the severity of the calcaneus at the time of injury. Extra-articular fractures, which do not involve the joint, include those caused by trauma and stress fractures.

The signs and symptoms of traumatic fractures may include sudden pain in the heel, inability to bear weight on that foot, swelling in the heel area, and bruising of the heel and ankle. On the other hand, the signs and symptoms of stress fractures may include generalized pain in the heel area that develops slowly, swelling in the heel area, and tenderness.

To diagnose and evaluate a calcaneal fracture, a foot and ankle surgeon will ask questions about how the injury occurred, examine the affected foot and ankle and order x-rays. In addition, advanced imaging tests are commonly required. Treatment of calcaneal fractures is dictated by the type of fracture and extent of the injury. The foot and ankle surgeon will discuss with the patient the best treatment, whether surgical or non-surgical, for the fracture.

For some fractures, non-surgical treatments may be used, such as rest, ice, compression, and elevation (R.I.C.E.). Rest is critical to allow the fracture to heal, ice reduces swelling and pain, compression and elevation reduce the swelling. Immobilization involves placing the foot in a cast or cast boot to keep the fractured bone from moving. Crutches may be needed to avoid weightbearing. For traumatic fractures, surgery to reconstruct the joint or in severe cases, to fuse the joint may be required. The surgeon will choose the best surgical approach for the patient.

Physical therapy plays a key role in regaining strength and restoring function whether the treatment for a calcaneal fracture is surgical or non-surgical. However, calcaneal fractures can be serious injuries that may produce lifelong problems such as arthritis, stiffness, and pain in the joint. Sometimes the fractured bone fails to heal in the proper position, which may lead to complications such as decreased ankle motion and walking with a limp due to collapse of the heel bone and loss of length in the leg. Patients often require additional surgery and/or long term or permanent use of a brace or an orthotic device (arch support) to help manage these complications.

If you are experiencing signs and symptoms of a calcaneal fracture, don’t hesitate to reach out to Dr Gilbert Huang DPM, a board-certified foot and ankle surgeon with vast experience in diagnosing and treating heel bone fractures. Early treatment and intervention can help manage and reduce the long-term consequences of calcaneal fractures.

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